Sesamoiditis and Foot Pain: How to Support Your Feet Naturally
If you’ve ever felt sharp or aching pain under the base of your big toe, you may be experiencing sesamoiditis—a common but often misunderstood cause of forefoot pain. At Neurohealth Wellness on the Northern Beaches, we help people relieve sesamoid pain through strengthening, mobility work, and proper footwear, rather than relying solely on supportive devices.
Understanding the Sesamoids
The sesamoids are two small, pea-shaped bones located beneath the first metatarsophalangeal joint (MPJ)—the joint at the base of your big toe. Despite their small size, they play a crucial role in your foot mechanics:
- Weightbearing: They transmit ground reaction forces (GRF) to the first metatarsal head, stabilising the medial forefoot during walking and running.
- Muscle and ligament attachment: They are key attachment points for the flexor hallucis brevis (FHB), adductor hallucis (ADH), abductor hallucis (ABH) muscles, and the plantar fascia. These connections allow the big toe to push off effectively and prevent deformities like hammertoes.
- Flexor hallucis longus (FHL) leverage: The FHL tendon runs between the sesamoids, using them to increase its mechanical advantage, which strengthens the toe during weightbearing activities.
Healthy sesamoids are essential not just for the big toe but for the entire forefoot, helping prevent overloading of the 2nd metatarsal and other common foot injuries.
What Causes Sesamoiditis?
Sesamoiditis is inflammation of the sesamoid bones and surrounding soft tissues, usually caused by repetitive stress rather than an acute injury. It’s common in runners, dancers, and people who spend long periods on their feet.
Symptoms typically include:
- Pain under the first MPJ when walking or running
- Pain worsened by jumping or pivoting movements
- Minimal swelling
- Discomfort when barefoot or in tight shoes
Unlike fractures or avascular necrosis, X-rays usually appear normal in sesamoiditis, although MRI can detect inflammation if necessary.
Supporting Sesamoid Health Naturally
Rather than relying on orthoses, you can often manage and prevent sesamoiditis through strengthening, mobility, and footwear choices:
1. Strengthen Your Feet
The muscles surrounding the sesamoids—FHB, ADH, ABH, and intrinsic foot muscles—play a major role in supporting the first MPJ. Strengthening these muscles helps the foot absorb forces naturally, reducing stress on the sesamoids.
Exercises include:
- Toe scrunches or towel curls: Place a towel on the floor and use your toes to scrunch it toward you.
- Marble pickups: Pick up marbles or small objects with your toes.
- Short foot exercises: Lift the arch of your foot without curling your toes, activating the intrinsic muscles.
Consistency is key—10–15 minutes daily can significantly improve forefoot stability over time.
2. Improve Foot Mobility
Restricted toe or ankle movement increases pressure on the sesamoids. Gentle stretching and mobility work help restore natural function:
- Big toe extension stretches: Sit or stand and gently bend your big toe upward, holding for 20–30 seconds.
- Calf stretches: Tight calves can alter gait mechanics and overload the forefoot.
- Ankle mobility drills: Circles or dorsiflexion stretches improve force distribution through the foot.
3. Wear Correctly Fitted Shoes
One of the most important strategies for sesamoiditis is proper footwear. Shoes should:
- Have a wide toe box to avoid compressing the sesamoids
- Offer flexible soles to allow natural foot motion
- Provide mild cushioning under the forefoot without restricting movement
- Avoid overly elevated heels that shift pressure forward
Many people experience dramatic improvements simply by switching to shoes that fit the shape and function of their feet, rather than squeezing their feet into narrow, rigid footwear.
4. Reduce High-Impact Stress
While strengthening and mobility work, it’s also important to manage load on the forefoot:
- Take breaks when standing for long periods
- Gradually build up high-impact activities like running or jumping
- Alternate surfaces where possible—softer surfaces reduce repeated stress on the sesamoids
When to Seek Professional Help
If pain under the big toe persists despite these strategies, it’s important to get a thorough assessment. Our chiropractors at Neurohealth Wellness can:
- Evaluate foot structure, movement patterns, and muscle function
- Provide tailored mobility and strengthening programs
- Recommend footwear or minimal supportive aids when needed
Early intervention ensures that sesamoiditis doesn’t progress to chronic pain or more serious forefoot injuries.
Restoring Foot Function, Restoring Life
At Neurohealth Wellness, our goal is to restore natural foot function, improve movement, and prevent future injury. By focusing on strength, mobility, and proper footwear, patients often find relief from sesamoid pain while improving overall foot health.
Take the first step toward pain-free feet today. Call us at (02) 9905 9099 or book online to arrange a consultation.
References:
- Sarrafian SK. Anatomy of the Foot and Ankle. Philadelphia: J.B. Lippincott Co., 1983.
- Aper RL, Saltzman CL, Brown TD. The effect of hallux sesamoid excision on the flexor hallucis longus moment arm. Clin Orthop Relat Res. 1996;325:209–217.
- Hillier JC, Peace K, Hulme A, Healy JC. MRI features of foot and ankle injuries in ballet dancers. Br J Radiol.2004;77:532–537.
